[Congressional Record Volume 146, Number 25 (Wednesday, March 8, 2000)]
[House]
[Pages H739-H747]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                               HMO REFORM

  The SPEAKER pro tempore (Mr. Tancredo). Under the Speaker's announced 
policy of January 6, 1999, the gentleman from Texas (Mr. Green) is 
recognized for 60 minutes as the designee of the minority leader.
  Mr. GREEN of Texas. Mr. Speaker, I thank our Democratic leader for 
allowing us to take the first hour tonight to talk about the Patients' 
Bill of Rights.
  I know that we have been talking about this for many years now it 
seems like, not only the last Congress but also last year and this 
year. We actually have a conference committee that is meeting now and 
had their first meeting. The concern has been expressed. It took that 
conference committee a good while to meet since it was appointed last 
year, and the concern was that the conference committee was not 
reflective of the final vote on the House floor.
  But be that as it may, that is the way life is. And so now a number 
of us are trying to make sure that we continue the effort to have real 
managed care reform in this Congress, not next year, because the issues 
are so important.
  American people support the need for real HMO reform. In fact, last 
year, with the bipartisan support of the Norwood-Dingell Patients' Bill 
of Rights bill, I think most Americans felt like we were going to see 
some Federal consumer protections. And yet, what we have seen is a bill 
passed in the Senate that was much weaker even than current law but 
that the American people supported.
  The Kaiser Family Foundation shows that 58 percent of Americans are 
very worried and somewhat worried that if they become sick their health 
care plan will be more concerned about saving money than providing the 
best treatment.
  According to the Kaiser Family Foundation, a full 80 percent of 
Americans support comprehensive consumer protections. That is up from 
71 percent last year. So the support is building; it is not decreasing.
  The Dingell-Norwood bill is so strongly supported by Americans, by 
moderates in both political parties, because it holds five principles 
that are so important. A person that buys insurance should get what 
they pay for, no excuses, no bureaucratic hassles. A lot of people 
think bureaucracy is just a function of the Federal Government. That is 
not the case. We can have insurance company bureaucracy that just cause 
hassles for people.
  What we need is an appeals process, independent external appeals, 
that if an insurance company or HMO company decides that you should not 
have a certain procedure, then you should be able to go to someone, an 
outside appeals process, that will work and be swift. Because if it is 
not swift, then they will just delay the coverage; and health care 
delayed is health care denied, Mr. Speaker.
  In an experience in Texas, and we have had an outside appeals process 
since 1997, so we have had over 2 years of experience in Texas with an 
independent appeals process, and frankly a little over half the appeals 
are being found for the patient.
  My constituents in Texas say, well, we would rather have better than 
a chance of a flip of a coin when somebody is making a decision on our 
health care. So we need to have an independent external reviews process 
that is timely.
  And again, the Texas experience shows that it is not that costly. In 
fact, it has actually cut down on lawsuits; and I will talk about that 
later. But it is being found in favor of the patient over half the 
time. And that is what is important, the people are getting their 
health care that they deserve quickly.
  The second issue is that we need to eliminate gag  clauses from 
insurance policies, that physicians can communicate openly and freely 
with their patients. A lot of companies are already doing that. And 
that is great. I want to

[[Page H740]]

congratulate them. But we also know that that standard does not only 
need to go from A-B-C company to X-Y-Z company, it needs to be a 
standard that everybody ought to feel comfortable with no matter who 
their insurance carrier is. They ought to be able to go to their 
physician and be able to have that physician tell them the best 
possible treatment.

  Now, whether their company covers it or not, that is not the case. It 
is the physician that ought to be able to talk to their patient.
  Third, a person who buys insurance ought to be able to have access to 
specialists. Women and children who are chronically ill should not need 
to get a referral every time they go see a physician. If you are a 
cancer patient or if you are a heart patient, or whatever, you should 
be able to go to your cardiologist or your oncologist without having to 
go back to your gatekeeper every time. Because, again, that is 
bureaucracy thrown up by the private sector, not the public sector, to 
ultimately limit people's ability to go to the doctor.
  The access to specialists is so important. I have a situation in my 
own district. I have a young lady who is in Humble, Texas, the 
northeast part of my district, and she was getting treatment at a local 
hospital complex that was close to her; and, all of a sudden, that 
doctor in that complex lost their contract; and so she was sent across 
town to Pasadena, Texas, which is also in our district. And that is 
great; I like them to go in our district. But, Mr. Speaker, for a 
person to go from one community to the other community because the HMO 
provider changed the contract is just wrong. Because, again, they were 
making her travel a great distance to get that specialist care that she 
needed.
  The fourth issue that needs to be included is that, when someone buys 
insurance, they need to know that they can get emergency treatment, 
they can go straight to the hospital.
  We all know the reason HMOs are successful. They go to providers and 
say, we guarantee you a thousand or 5,000 or 10,000 patients; and so 
they will go to the doctors, the hospitals, and emergency rooms and 
say, we will put you on our preferred list and that way you will get 
patients.
  The problem is that when someone has an emergency, they need to be 
able to go to the closest emergency room possible. And again, I use the 
example and have used on the floor here of the House many times that, 
if I am having chest pains in the evening, how do I know that it is not 
a heart attack and it may just be the pizza I had. I need to go to the 
closest hospital or the closest health care provider. And then once the 
decision is made, then you can go on to your hospital that has a 
contract with your HMO provider. But you need to be able not to have to 
pass by emergency rooms to go to an emergency room that may have a 
contract. So that is important.
  Also, oftentimes you cannot always get preauthorization for emergency 
room treatment. The last thing people need is to have the toll-free 
number and to be put on hold while they are having their chest pains or 
whatever illness or emergency they may be having.
  Fifth, a person who buys insurance should be assured that an 
insurance company is accountable if that insurance company is making 
decisions in the place of a health care provider or doctor. And we need 
to make sure that the decision maker is the one responsible and that 
the decision maker be held accountable if that patient is harmed by 
that decision.
  I would like to tell a story. I spoke a couple of years ago to the 
Harris County Medical Society, Mr. Speaker; and after it was over, 
during the speech, I talked about my daughter who had just started 
medical school. She had been in medical school for 2 weeks. And I 
laughed and I said, my daughter is in medical school. She has been 
there for 2 weeks, but she is not ready to be in competition to do 
brain surgery.
  After I finished talking about Social Security and the budget and 
everything else, the first question was a doctor said, you know, your 
daughter, after 2 weeks in medical school has more training than the 
people who are telling me how to treat my patients.
  That is wrong, and that is what we need to change. And that is why 
real HMO reform is important. If doctors are being second guessed by a 
decision-maker who may not have the training that they need, that 
decision-maker needs to be accountable.
  Hopefully, they do have some training and they are. I know the ideal 
for HMOs and managed care is it can work. But what we have seen in our 
country is that the managed care issue and the companies have gone from 
providing whole-person coverage to actually denying coverage in a lot 
of cases.
  That is why one of the most important parts of the bill that passed 
this House with an overwhelmingly bipartisan vote was the decision-
makers need to be accountable. If doctors are accountable, then 
decision-makers need to be if they are telling those doctors how to 
practice medicine.

  Now, what we will hear from the insurance company, and we have heard 
it when this passed that bill last year, is that we are going to have 
the cost increases, that we will see the cost of insurance going up. 
Well, Mr. Speaker, we had increases in HMO costs this last year and 
that bill had not even become law yet. So I think we are seeing 
increases where that happens.
  Again, going back to my own experience in the State of Texas. The 
State of Texas passed what I consider and I think a lot of folks around 
the country consider the best managed care reform in the country in 
1997; and there had been no overwhelming increases other than what 
happened based on HMOs increasing everywhere.
  Dallas, Ft. Worth, Houston, Harris County, there have been no 
increases based on Texas law as compared to other parts of the country 
that do not have it. Typically, they have increased the same. So we 
have not seen a huge number of lawsuits or cost increases.
  The other thing they say, well, you are opening up the court system 
to lawsuit. Again, after 2 years' experience in Texas, we have not seen 
but four or five lawsuits filed. In fact, three of them are filed by 
one attorney in Ft. Worth, Texas.
  What we have seen, though, is that if you have strong accountability 
and strong independent reviews, the independent reviews actually will 
take the place of having to go to the courthouse.
  In fact, people do not want to go to the courthouse. They typically 
want the health care. And if you have an external appeals process that 
is swift and fast, that will save people from having to go hire an 
attorney and go to the courthouse.
  Again, in the State of Texas, because over half the cases of the 
appeals are being found for the patient and the insurance companies are 
saying, okay, we will pay for that, there is no reason to go to the 
courthouse. Frankly, if the insurance company is found to be okay, 
their decision had some medical benefit, then that gives that patient a 
little saying, well, sure you can go hire your attorney, but now we 
know when everything is on the table. So we have not had that 
overwhelming cost increase.
  One other thing I want to mention is the concern about employers 
being sued. In fact, in our debate last year and even as recently as 
last week, I had an employer express concern that, I do not want to be 
sued. In the Dingell-Norwood bill, or the Norwood-Dingell, depending on 
which side you are on, I guess, there is specific language in there 
that prohibits an employer being sued unless this employer is making 
medical decisions.
  Again, I use the example of my own experience of purchasing insurance 
before I was elected to Congress for a small company. And we contracted 
with three different insurance companies, or contacted them to get 
prices, and we were not in the position of making those medical 
decisions or saying to deny coverage.
  Now, we could buy a Chevrolet plan or we could buy a Cadillac plan. 
But employers should not be held responsible. In the bill that passed 
this House, employers are not responsible, although we are hearing that 
thrown up by a lot of these associations here in Washington, and 
sometimes I think they mostly want to raise funds and get membership 
instead of actually address the problem of people having real health 
insurance that their employers buy. And, as an employer, we paid for 
that insurance. And I wanted to make sure that my employees received 
the insurance that we paid for, and oftentimes I felt like I was the 
arbitrator

[[Page H741]]

between the insurance company and my own employees because oftentimes 
they did not want to pay.

  We have some great Texas experience over the last 2 years. I know 
other States have passed legislation like what Texas has passed that 
set the groundwork. It is ideal. We have used the States as a 
laboratory. We see it has worked in Texas in a large, urban State with 
both rural and urban area, both poor and wealthy population. It is 
something we can do on a national basis to make sure that every 
insurance policy, not just those that are licensed by the State Board 
of Insurance in the State of Texas or the Insurance Commission, but all 
insurance policies are covered.
  The reason we have national legislation is that over two-thirds of 
the insurance policies in my own district in Houston are not covered by 
State law. They are covered under ERISA. They are covered under Federal 
law. And that is why we need to pass Federal law to complement what the 
States can do.
  I see that my colleague, the gentleman from Texas (Mr. Rodriguez), is 
here and my colleague, the gentleman from Arkansas (Mr. Berry), is 
here. It is great to have two Members from our part of the country who 
do not have accents speaking.
  Mr. Speaker, I yield to my colleague, the gentleman from Arkansas 
(Mr. Berry).
  Mr. BERRY. Mr. Speaker, I want to thank my distinguished colleague, 
the gentleman from Texas (Mr. Green), for yielding; and I appreciate 
his leadership in this matter and also the leadership of the State of 
Texas. I believe they were the first State to actually deal with this 
on the State level, and it is a good thing.

                              {time}  1700

  It is amazing to me, Mr. Speaker, that here we are, it is 5 o'clock 
in the afternoon, and we are doing special orders. That is not what the 
American people sent us here to do. They sent us here to deal with 
things like the Patients' Bill of Rights, prescription drug coverage 
for our seniors, many other issues that we need to be taking care of. 
Yet here we are basically shut down at 5 o'clock in the evening.
  Mr. Speaker, 80 percent of the American people have private health 
insurance plans. They are enrolled in managed care plans. In many 
cases, they are required to be enrolled in managed care plans because 
their employers have contracted with these companies to achieve cost 
savings. We need managed care. We know that we have got to control the 
cost of health care. But it can be done right. We must leave the health 
care decisions to our professionals, the people that know what they are 
doing when they make a decision. It should not be left to someone with 
no training and their only objective is to save the insurance company 
money.
  Unfortunately, because we are enrolled in managed care plans, 
patients are forced to battle with their HMOs when their only concern 
should be to recover from an illness. There have been many stories from 
people who have lost loved ones or had loved ones seriously damaged 
because someone behind a desk, not a doctor, made a bad decision. The 
Norwood-Dingell bill allows managed care, and it allows it to do what 
it is set up to do; and at the same time it protects businesses from 
unnecessary lawsuits and does the job that we are going to have to do 
to continue to have managed care in this country.
  Last October, the House passed a sound Patients' Bill of Rights, the 
Norwood-Dingell bill that gave the protection and rights to medical 
patients. While we delay passage of a strong bill, millions of American 
families needlessly suffer from the consequences of allowing HMO 
bureaucrats to make medical decisions. The American people deserve a 
Patients' Bill of Rights.
  This is not a Republican or a Democratic issue. When you have a heart 
attack and you need to go to an emergency room, they do not ask you 
which party you vote in, which party you support. We need a Patients' 
Bill of Rights that ensures patients receive the treatment that they 
have been promised and paid for, that prevents HMOs and the other 
health plans from interfering with doctors' decisions regarding the 
treatment of their patients, ensures that patients could go to any 
emergency room during a medical emergency without calling their health 
plan for permission first, ensures that health plans provide their 
customers with access to specialists when needed because the complexity 
and seriousness of that patient's illness, allows HMOs to be sued or 
held accountable if a patient is denied care in States that choose to 
allow such suits.
  The American people are asking us to pass this legislation. Both 
Democrats and Republicans want this legislation to become law. Let us 
give the American people what they want. Let us do what we were sent 
here to do. We all need to take a stand for the rights of managed care 
patients and make sure they receive the high quality of health care 
they deserve. We need to pass a Patients' Bill of Rights that is 
meaningful and that provides real patient protections.
  I know with Democrats and Republicans working together, we can put 
together a strong bill in the conference committee that will give us 
the protections that will protect business, that will provide for an 
efficient system to provide health care for our people. It has been 4 
months since the House passed this bill. It is time for the House to do 
something about this. It is time for the Senate to do something about 
this. The American people should not have to wait any longer. We need 
to get to work on finishing the job that the American people sent us to 
do.
  Mr. GREEN of Texas. Mr. Speaker, I want to compliment the gentleman 
from Arkansas (Mr. Berry) for his leadership on this issue not only 
here on the House floor tonight but for the last over a year with our 
moderate-conservative coalition of Democrats, our Blue Dog Coalition. 
And I will not ask you what a Blue Dog is, but your leadership has 
helped a great deal.
  Mr. Speaker, I yield to my colleague from San Antonio, Texas (Mr. 
Rodriguez), a former roommate for a year and served with him in the 
State House when I was in the legislature.
  Mr. RODRIGUEZ. I thank the gentleman from Texas (Mr. Green) for 
taking the leadership to talk about the importance of access to health 
care throughout this country. Managed care reform is needed 
drastically.
  I will just quickly give an example of some of the problems we have 
encountered in Texas. We have recently had a situation where one of the 
particular companies decided to cut a lot of the rural counties out 
from having access to health care. The reason why is the reimbursement 
on Medicare is lower for rural areas than it is for urban areas, so 
there is definitely areas that we need to work on to make sure that 
those people in rural Texas and rural America also get the same type of 
access to health care that is drastically needed.

  In addition to that, one of the things that I know the gentleman from 
Texas (Mr. Green) knows full well is the fact when we talk about the 
Patients' Bill of Rights, the right for everyone to be able to see the 
doctor of their choice, especially when they encounter a situation 
where they need to see a specialist, an accountant, an insurance person 
should not be the one to dictate whether they should see that doctor or 
not. It should be that particular doctor, the one to have the say-so.
  So the Patients' Bill of Rights that we have been pushing for the 
last 2 years is critical. I am hoping that the Congress will decide to 
do the right thing on an election year, and hopefully we will be able 
to make something happen when it comes to the Patients' Bill of Rights 
bill. I also wanted to touch base, and I know the gentleman from Texas 
(Mr. Green) knows full well the fact that we have a large number of 
uninsured in this country. It has gone over 44 million now. Texas is 
one of the largest of uninsured individuals. We are talking about 
individuals, working Americans, working Texans. These are people that 
are making too much money to qualify for Medicaid, not old enough to 
qualify for Medicare, yet at the same time are not making a sufficient 
amount of resources to be able to cover their families and have access 
to insurance.
  I know that the CHIPs program, the children's insurance program, has 
been a great program that has been in the forefront and thank God for 
President Clinton's effort and the Democrats in pushing that program 
forward. But we

[[Page H742]]

still have a lot to do. States such as Texas, for example, that was one 
of the last States who actually moved to approve the CHIPs program, 
decided to move and only fund 55 to 60 percent, so that means that 10 
kids that qualify, we will only be able to service six of those based 
on the resources that were allocated.
  So there is a real need for us to reach out and making sure that 
those youngsters get access to health care. I know from a Hispanic 
perspective, and I head the task force for the Hispanic caucus, we want 
to make sure that the parents of those children also have an 
opportunity to get insurance. Those individuals, those parents are also 
parents that are out there working hard and trying to make things 
happen for their families. We are hoping that we can expand that CHIPs 
program to the parents of those children to make sure that they get 
access to health care.
  Aside from the fact that things are getting worse in terms of the 
uninsured and things seem to be getting worse also for managed care 
systems, we also need to look at Medicare. In the area of Medicare, it 
is ironic to think that right now if you are on Medicaid for the 
indigent, you get access to prescription coverage. Yet if you are a 
senior citizen, you do not have access to prescription coverage.
  It does not make any sense. It was started, Medicare, during a time 
when not too many prescriptions were being utilized in the area of 
getting people taken care of, and now there is a need for prescription 
coverage and the cost to those senior citizens as we well know is 
astronomical. In fact, studies that were done throughout this country 
and specifically in my district, we did a study and we found that our 
senior citizens are getting charged more for the same prescription than 
someone who is on a major insurance company. So that the pharmaceutical 
companies are basically giving breaks and giving discounts to 
individuals, but when it comes to our senior citizens that are on 
Medicare they are not getting those same prescription coverages.
  I know that they are spending a lot of money on lobbying; I know that 
again some of our legislation to allow our senior citizens to have 
access to Medicare, but it is something that I feel real strongly 
about, that we need to make sure that our senior citizens get that 
access to that prescription coverage and if nothing else for them to 
get it at the same cost that those other individuals get when they go 
out there and purchase that prescription.
  One of the other things when we look at the issue of health care, and 
it goes beyond in terms of not only the uninsured, the importance of 
prescription coverage but also in terms of veterans. Last year we 
worked real hard to try to get a $3 billion increase in the veterans 
for access to health care. I know that in committee, the Republican 
side fought us extremely hard. They also fought us on the House floor 
on an amendment to add those $3 billion. We were able to add $1.7 
billion. This year, I was real pleased to see the administration come 
up with a $1.5 billion increase on veterans health care; but in all 
honesty, that is just to keep up with existing cost.
  There is a real need for us to reach out to those veterans. There is 
a need for us to make sure we fulfill that agreement that we made to 
all those veterans out there to have access to health care. One of the 
things that I have seen up here in the last 3\1/2\ years is the fact 
that as Americans and as agencies that are responsive and talking in 
our behalf, they definitely did tell our veterans that they were going 
to have access to health care. That is one of the things that we have 
neglected to do.
  One of our obligations is that we have to make sure that those 
individuals get access to that health care. This year, we are moving 
forward to try to fulfill some of those needs in the area of veterans 
needs as well as TRICARE. If I could, I want to just touch base with 
the gentleman from Texas (Mr. Green) on TRICARE. TRICARE is an issue of 
those retirees that are out there. A lot of them are having a great 
deal of difficulty, and these are the retirees, military individuals, a 
little different than the VA, a different source; but it is one of the 
areas that they are also having a great deal of difficulty. We are 
hoping to put some additional resources in that area and to make some 
things happen for our military retirees that are out there. In 
conjunction with all the other needs that we have on health care, there 
is a real need for us to move forward in these areas.
  I want to thank the gentleman from Texas (Mr. Green) for the 
leadership that he has taken in this area.
  Mr. GREEN of Texas. I thank the gentleman from Texas (Mr. Rodriguez) 
for being here today. In fact you have covered so many issues that are 
important. TRICARE obviously even in Houston where we do not have an 
Army medical hospital, a Navy hospital or whatever, we have a VA but we 
have a lot of veterans. It is an issue there. You were in the state 
legislature and a State House member in 1995.
  Mr. RODRIGUEZ. Yes, I was.
  Mr. GREEN of Texas. In 1995, the State of Texas passed the first 
strong managed care reform bill, HMO reform bill, passed both the House 
and the Senate and the governor vetoed it in 1995.
  Mr. RODRIGUEZ. Exactly.
  Mr. GREEN of Texas. In 1997 you were elected to Congress in a special 
election, I believe.
  Mr. RODRIGUEZ. Yes, I was.
  Mr. GREEN of Texas. Were you in the legislature in 1997?
  Mr. RODRIGUEZ. Yes, I was.
  Mr. GREEN of Texas. You remember when the legislature passed the HMO 
reform bill or managed care reform bill in Texas and it was passed by 
the legislature and it became law this time, though; but the governor 
did not veto it, he did not sign it, it became law without his 
signature.
  Mr. RODRIGUEZ. That is right.
  Mr. GREEN of Texas. That is the history of managed care reform in 
Texas. There are things that I am proud to be a Texan always; but 
obviously we have not done as well as we should on the CHIPs program 
and those prescriptions that you talk about on Medicaid; I think our 
seniors in Texas only receive three prescriptions. That is better than 
none, obviously, if you are poor and on Medicaid.
  Mr. RODRIGUEZ. Let me just share in that area, other States actually 
get more. We as a State have chosen not to participate fully on that. 
That is why we only get three prescriptions, because the State chooses 
to put a limit on those prescriptions. In fact, I authored some 
legislation to force the Texas House to move forward on that, and I was 
able to get six prescriptions if you are in a nursing home, six 
prescriptions if you are in a hospital; but if you are at home, you 
still just get three.
  Mr. GREEN of Texas. That is just for people who qualify for Medicaid.
  Mr. RODRIGUEZ. That is right. Medicaid, which means indigent. One of 
our biggest problems as you indicated is those people who make a little 
bit above the indigent level, which is $12,700 a year for a family of 
three, those that make a little bit over that find themselves not being 
able to qualify for Medicaid but find themselves without any insurance 
whatsoever and having a job where they cannot afford to have insurance.
  The other issue as we well know is the issue of Medicare. That is an 
issue that also we find ourselves with a lot of senior citizens not 
being able to have access to prescription coverage.
  Mr. GREEN of Texas. Let me get back to our managed care issue. 
Sometime we can have a discussion on the floor on that. I know I have 
some other colleagues who are going to be here. Mr. Speaker, let me 
talk about some of the numbers that we have seen. I quoted earlier the 
Kaiser Harvard study of doctors. Almost 90 percent of doctors report 
denials by managed care plans of services they requested for their 
patients.

                              {time}  1715

  We can see how many, over 80 percent overall portion of doctors 
saying their request for some type of health, 87 percent; 79 percent 
portion saying their request for prescription drugs had been denied; 69 
percent portion say their requests for diagnostic tests have been 
denied. Sixty-nine percent of the doctors are saying they have had 
experience with that.
  Again, that is why we need to make sure that doctors can talk to 
their patients and have the freedom of speech when they talk to their 
patients.
  That is why it is so important that we pass the conference committee

[[Page H743]]

work as diligently as we can, but that they make sure they do not send 
us out a fig leaf, they do not send us out something in an election 
year that is just saying the House and the Senate passed a managed care 
reform. We need a real Patients' Bill of Rights, real HMO reform.
  This House took the bold step last year and passed, on a bipartisan 
vote, the Dingell-Norwood bill. That is a strong bill that was 
patterned after what States have found successful.
  I see my colleague from Houston, the gentlewoman from Texas (Ms. 
Jackson-Lee). We share Houston, Texas, and I would like to yield time 
to her.
  Ms. JACKSON-LEE of Texas. Mr. Speaker, I thank the gentleman from 
Texas (Mr. Green) for his leadership. This is a particularly important 
special order, and it is long overdue for us to find common ground on 
HMO reform.
  It is extremely important because, Mr. Speaker, Americans are asking 
us in a bipartisan manner to address this issue. I do know that the 
conferees have been appointed; and I do know, however, that their work 
is not done and that is really the crux of the issue.
  My good friend, the gentleman from Texas (Mr. Green), did do very 
able work, both, I believe, in the House in the State and as well as in 
the Senate in the State of Texas. I, like him, am proud of the 
legislators who a long time ago, 1995, and that is a long time ago, 5 
years ago, passed a Patients' Bill of Rights. Unfortunately, those 
bills did not deem to find their way on our governor's desk to be 
signed, but they were in place.
  I think the key that I want to say, besides the fact that it did not 
get signed by our governor, is that it works; that we have not heard 
any complaints or any outrageous imbalance that has occurred. It has 
not gone far enough, of course; but we have not heard any major 
complaint from constituents or managed care entities or hospitals about 
how that particular legislation has worked. I think that is a good 
point, and the reason why it is a good point because what we have heard 
in the discussion, even though we managed to get this bill off the 
floor of the House and passed, is the apprehension and fear of what 
will happen, what disarray will occur in the insurance industry if we 
pass a Patients' Bill of Rights.
  I just simply want to share these very simple aspects of the Norwood-
Dingell bill, bipartisan bill, hard-worked bill, and, Mr. Speaker, I 
want to know whether or not these are endangering our system as we know 
it. Direct access to specialty care simply means that if someone is a 
diabetic or if they have high blood pressure and they need specialists 
in that area, they can immediately go to their HMO, go to that 
particular specialist, rather than having the referral.
  I have a mother who obviously is a senior citizen, and every time I 
have to hear her saying I have to get referred to the doctor who deals 
with diabetes or I have to get referred to the doctor that deals with 
my heart disease, that kind of almost denial of service to our seniors 
and others who need this kind of care makes it more difficult for them 
to access health care. They have to worry about the appointment with 
the specialty person by way of waiting for the referral to come 
through, and I think that that makes it very difficult.
  Emergency room care is enhanced and improved under the Norwood-
Dingell bill. That means that someone is not turned away. We have heard 
so many tragic stories. One young man, who was an amputee, who was here 
on the floor of the House, and the reason is because when something 
happened to him as a little nine year old, I believe was his age, his 
parents had to travel past a close emergency room because they were not 
covered or that emergency room said they were not covered.
  These are tragedies in America, in a country as wealthy as we are, 
that should not occur.
  The bill also includes an HMO appeals process by a panel of experts 
and HMO liability for refusal to authorize lifesaving treatments. In 
essence, it allows one to hold their HMO accountable.
  A Kaiser Family Foundation study found that 73 percent of voters 
believe that patients should be able to hold managed care plans 
accountable for wrongful delays or denials. The same study also found 
that 61 percent of patients complained of the decreased amount of 
time doctors spend with patients; 59 percent complained of the 
difficulty in seeing medical specialists; and 51 percent complained of 
the decreased quality of care for the sick. We can address this.

  First of all, we can applaud those medical professionals that we do 
have but we can address this by simply passing the Patients' Bill of 
Rights.
  I would like to share, before I close, a sample of some stories that 
would argue that we need to hastily run to the conference and get this 
bill out and to the floor and to the Senate and let it be signed by the 
President of the United States.
  First of all, I think it is important to note that we have a lot more 
to do other than the Patients' Bill of Rights and that is, of course, 
we need to deal with the prescription discount for our seniors. I have 
had a study done in my district. It has shown that one can get drugs 
cheaper in Mexico and elsewhere other than the City of Houston. It 
shows that, in particular, my seniors have to take monies that they 
would use for food and rent to be able to pay for their drugs, a huge 
cost, $800 a month or more for some seniors who have lifesaving needs 
or drugs that provide lifesaving opportunities for them.
  Why can we not simply pass a very simple bill that allows for those 
drugs to be discounted? Why are we not adhering to the heed and the cry 
of those we pretend to represent and provide seniors with that 
discount?
  As I have said, this Patients' Bill of Rights, a part of HMO reform, 
really is urgent; and I have examples right out of my community. John 
McGann found that he had AIDS and thought that he would be covered 
adequately by his health insurance. When he filed a claim for AIDS-
related treatment, he found out that his benefits had been capped 
retroactively. Since his insurance was through an ERISA group health 
plan, the State consumer protection plan did not apply. He sued 
claiming discrimination and lost. Unfortunately, John McGann died, and 
the ruling on his case was upheld by the Supreme Court.
  Therein lies a great need for us to intervene legislatively.
  Let me lastly say, Wendy Connelly from Sherwood, Oregon, went to a 
local hospital with symptoms of what she thought was a heart attack. 
When she got to the hospital, she found out that she was suffering from 
a previously undiagnosed thyroid imbalance, not a heart attack, and she 
might have been at that point a little grateful.
  The bill arrived for her treatment and the HMO denied her claim 
because her treatment was not considered to be emergency care.
  The HMO based its decision on her final diagnosis, not on the symptom 
that caused Wendy to go to the hospital.
  Wendy fought the decision by her HMO with the help of her doctors and 
the hospital. She prevailed on her appeal, but she found out that the 
denial was a routine practice of insurance companies that emergency 
room visits had to result in a final diagnosed emergency.
  Then what are we saying, Mr. Speaker? That when people feel that they 
are having a heart attack or some other dangerous symptom that may 
result in a loss of life that they should just sit here and say, my 
God, let me sit down and think is it my thyroid or something else 
because I will not get the benefit of my HMO that I am paying for 
because they will deny me the access to emergency room care?
  We do want more of our citizens to be preventive or to deal with 
medicine from a preventive way to take care of themselves, but there 
are tragedies that are occurring every day. John McGann lost his life. 
Wendy Connelly was insulted with her HMO denying her a coverage. Joyce 
Ching had rectal bleeding and wound up dying, who she had in her 
family, her father died of colon cancer at a young age, and she was 
referred or denied a specialist, unfortunately, even though she had a 
history of colon cancer when she had rectal bleeding.
  All of those are, I believe, indications, as my colleague has 
indicated by this special order today, that we are at a crisis in 
health care. We need to have the Patients' Bill of Rights. We need to 
have the prescription discount for our seniors; and, frankly, we need 
to have the Norwood-Dingell bill that will hold

[[Page H744]]

HMOs accountable for some of the negative aspects of health care that 
they generate.
  I hope that we can move this legislation along, and I thank the 
gentleman from Texas (Mr. Green) for his leadership on this issue in 
bringing this particular special order to us. I would frankly say, can 
73 percent of the American population be wrong? Can those who believe 
we can do better be wrong?
  I would simply ask that we quickly pass these legislative initiatives 
so we can bring real health care to the American public.
  Mr. Speaker, I rise today to add my voice in support of the 
Bipartisan Consensus Managed Care Improvement Act, the Norwood-Dingell 
patient protection legislation. This legislation sets a Federal 
standard to ensure that Americans will have basic consumer protection 
in their health care plans.
  Americans have waited a long time for us to enact this legislation. 
This balanced, reasonable legislation represents the best hope for 
passing meaningful protection from abusive practices for patients.
  In the past few years, there has been a dramatic change in the way 
people receive and pay for health care services. More than three out of 
four people are enrolled in managed care plans--health maintenance 
organizations (HMOs), preferred provider organizations, and point of 
service plans.
  Managed care is an attempt to improve access to preventive and 
primary care, and to respond to high health care costs. Managed care 
plans were designed to control unnecessary and inappropriate medical 
care.
  However, many Americans believe that instead of improving the health 
care system, managed care plans have increased the number of problems 
through bureaucratic redtape and denials of care.
  Thus, the reform movement here in Congress sought to give consumers 
certain protections when receiving health care services. The original 
Patient's Bill of Rights was one attempt at patient protection 
legislation. In an effort to propose managed care reform that could be 
supported by everyone, the Bipartisan Consensus Managed Care 
Improvement Act was offered by Representatives Norwood and Dingell.
  There are four key elements to the Norwood-Dingell managed care 
reform proposal. These reforms include: (1) direct access to specialty 
care; (2) emergency room care; (3) an HMO appeals process by a panel of 
experts; and (4) HMO liability for refusal to authorize life-saving 
treatments.
  These reforms are basic consumer protections that ensure that 
patients receive the best quality of care needed. In addition, this 
bill provides for an expanded choice of physicians, access to 
prescription drugs and continuity of care when a doctor leaves a 
network.
  I support this legislation because I believe Americans deserve 
quality health care from their managed care plans. I have received many 
letters from constituents that express their dissatisfaction with the 
care that they received from HMO's.
  A Kaiser Family Foundation study found that 73 percent of voters 
believe that patients should be able to hold managed care plans 
accountable for wrongful delays or denials. The same study also found 
that 61 percent of patients complained of the decreased amount of time 
doctors spend with patients; 59 percent complained of the difficulty in 
seeing medical specialists; and 51 percent complained of the decreased 
quality of care for the sick.
  Last spring, many of my constituents used the power of the Internet 
to add their names to a national online petition in support  of the 
Patient's Bill of Rights. These constituents believed that this 
legislation was crucial to provide consumers with the basic protections 
that are necessary to ensure that they receive quality care.

  To further Illustrate how important this legislation is to the 
American people, here are some stories of people who have true HMO 
horror stories:
  In Houston, TX, John McGann found out that he had AIDS and thought 
that he would be covered adequately by his health insurance. When he 
filed a claim for AIDS related treatment, he found out that his 
benefits had been capped retroactively. Since his insurance was through 
an ERISA group health plan, the state consumer protection plan did not 
apply. He sued claiming discrimination and lost. Unfortunately John 
McGann died, and the ruling on his case was upheld by the Supreme 
Court.
  Wendy Connelly from Sherwood, OR, went to a local hospital with 
symptoms of what she thought was a heart attack. When she got to the 
hospital, she found out that she was suffering from a previously 
undiagnosed thyroid imbalance, not a heart attack. The bill arrived for 
her treatment and the HMO denied her claim because her treatment was 
not considered to be ``emergent care.'' The HMO based its decision on 
her final diagnosis, not on the symptoms that caused Wendy to go to the 
hospital. Wendy fought the decision by her HMO with the help of her 
doctors and the hospital. She prevailed in her appeal, but she found 
out that the denial was a routine practice of insurance companies--that 
emergency room visits had to result in a final diagnosed emergency.
  Glenn Nealy suffered from unstable angina and was treated with a 
strict regimen by his cardiologist. His employer changed health plans, 
but Glenn was assured that he would continue to be treated. Glenn 
attempted to go to a doctor that participated in the plan, but after 
several administrative delays he suffered a heart attack and died. 
Before his death, he had also requested several times to see his 
original cardiologist, but was denied.
  Joyce Ching from Agoura, CA, died from misdiagnosed colon cancer in 
1994. When she complained of severe abdominal pain and rectal bleeding, 
an HMO doctor told her that her symptoms could be treated with a change 
in diet. She was refused a referral to a specialist until it was too 
late. In the early diagnosis stage, the doctor failed to ask Joyce for 
a family history, which would have revealed that her father also died 
of colon cancer at a young age.
  Buddy Kuhl, from Kansas City, MO, required special heart surgery 
after a major heart attack. He could not get the surgery in his 
hometown, so he was referred to a hospital outside of the HMO service 
area. Initially, the HMO refused to certify the surgery, but later 
agreed after a second doctor confirmed the recommendation of the first 
doctor. A few months later, Buddy found that he needed a heart 
transplant. The HMO refused to pay for a transplant, but Buddy got on a 
transplant list anyway. However, he died while waiting for a 
transplant.
  In each of these cases, an HMO bureaucrat made a decision that caused 
the death, or delayed care for a patient in need. Although Wendy 
Connelly survived her illness, she had to fight for her benefits. The 
other patients were not so lucky.
  I once heard someone say, ``As long as you are healthy, HMO's are 
fine, but the trouble starts when you get really sick.'' This statement 
is a sad commentary on the state of health care service in this 
country. That is why the Norwood-Dingell bill is so important. People 
need quality health care whether or not they are sick.
  The Norwood-Dingell proposal includes access to specialty care. In 
the cases I cited several of the patients were denied access to 
specialists. Joyce Ching was refused an initial referral to a 
gastroenterologist and Glenn Nealy was refused an initial referral to a 
cardiologist. In these cases, the delay was fatal. If a specialist is 
needed, patients should be able to receive those services.
  The Norwood-Dingell bill also includes access to emergency room care. 
Wendy Connelly received emergency room care, but her claim was denied 
because her final diagnosis differed from the heart attack symptoms she 
first experienced.
  Under this proposal, no patient would be denied a claim for non-
emergent care if the symptoms seemed more serious.  Emergency care 
should be available at any time without prior authorization for 
treatment.

  The third major reform is an HMO appeals process by a panel of 
experts. In each of these cases, an independent review panel probably 
would have overturned each of the decisions made by the HMO.
  The expert panel would consist of an independent group of 
professionals, not a panel of insurance agents. Particularly in the 
case of Buddy Kuhl, a review panel would have determined that his 
condition was too serious to wait as long as it took for a confirmation 
of the original diagnosis.
  Finally, the Norwood-Dingell proposal would impose liability on an 
HMO for refusal to authorize life-saving treatment. Although this is 
one of the most controversial aspects of this legislation, the ability 
to hold an HMO liable for certain decisions is an important reform for 
patients.
  In some of the cases I cited earlier, the victims' families could not 
recover damages from the HMO because it was governed by ERISA (the 
Employee Retirement Income Security Act regulations), which only allows 
a patient to recoup losses caused by the delay or denial of care.
  The Norwood-Dingell measure expands health plan tort liability by 
permitting state causes of action under the ERISA to recover damages 
resulting from personal injury or for wrongful death for any action 
``in connection with the provision of insurance, administrative 
services, or medical services'' by a group health plan.
  In my home State of Texas, we have The Health Care Liability Act that 
allows an individual to sue a health insurance maintenance 
organization, or other managed care entity for damages for failure to 
exercise ordinary care when making a health care treatment decision.

[[Page H745]]

  The first lawsuit to cite Texas' pioneering HMO liability law, filed 
against NYLCare of Texas, demonstrates why this measure is important. 
NYLCare's reviewers made the decision to end hospital coverage for a 
suicidal patient. Despite his psychiatrist's objections, the patient 
did not protest the HMO's decision to release him from the hospital, 
and, shortly after discharge, he killed himself.
  In her decision in this case, 5th Circuit Judge Vanessa Gilmore 
wrote:

       [I]n light of the fundamental changes that have taken place 
     in the health delivery system, it may be that the Supreme 
     Court has gone as far as it can go in addressing this area 
     and it should be for Congress to further define what rights a 
     patient has when he or she has been negatively affected by an 
     HMOs decision to deny medical care. . . . If Congress wants 
     the American citizens to have access to adequate health care, 
     then Congress must accept its responsibility to define the 
     scope of ERISA preemption and to enact legislation that 
     ensures every patient has access to that care. Corporate 
     Health Insurance v. The Texas Dept. of Insurance, 12 F. Supp. 
     2d, 597 (S.Tx. 1998).

  This case will set a standard for patients who have been denied care 
or refused treatment. Critics claim that this provision will expand 
employer liability, but this is not true. Detrimental HMO decisions 
will effect the HMO, not the employer. As in any case of liability, the 
decision-maker must accept the consequences of an unwise decision.
  The Norwood-Dingell proposal should not be controversial for any 
Member of Congress who is serious about protecting patients from 
insurance company abuses. The patients, families, and doctors deserve 
to make decisions about health care services.
  If the health care industry continues to act as a well-heeled special 
interest group that puts profits ahead of patients, then these reforms 
deserve our unequivocal support. I urge my colleagues to support this 
bill.
  Mr. GREEN of Texas. Mr. Speaker, I am so glad the gentlewoman from 
Texas (Ms. Jackson-Lee) brought up those because oftentimes to pass 
legislation we have to show the public support and, like the 
gentlewoman said, over 80 percent support now for a real Patients' Bill 
of Rights and managed care reform.
  We have to show the need for it, not just the public support. The 
gentlewoman's example of the three people she gave, particularly the 
last one, and March being colorectal cancer month it is so important 
that we look at our family history and that HMO and the physicians need 
to look at that so someone can go and be screened to make sure, because 
colorectal cancer like anything else, the earlier the detection the 
more chance there is of survival, and the less money it will cost for 
treatment.
  All of us do lots of newsletters, Mr. Speaker, and I know I read all 
of mine, particularly the ones that people write in and give particular 
opinions. So we sent one out and had town hall meetings in January and 
February of this year and so some interesting ones came back, 
particularly on HMO reform, and to point out the need for it. This 
person from Humble, Texas, part of the district I represent, every time 
I get my referral, my 6-month referral for my cancer, I get a 9-month 
checkup not 6 months as I should get, and a lot of things they should 
pay for they will not.
  Instead of a person obviously who has had a history of cancer and has 
to go back, should be going back for every 6 months, her HMO says, no, 
she has to go back every 9 months and she has to get permission even to 
go back for that 9 months.
  That is what the Dingell-Norwood bill would change, that that person 
should go back and get that checkup and they should not have to go back 
to their gatekeeper before they can go to their oncologist or their 
specialist, hopefully for a 6-month checkup instead of waiting another 
3 months for it.
  Another from north side Houston, in fact an area where I grew up, why 
cannot our family doctor have more control over us in the hospital? 
Please answer why that is the case.
  Well, what happens with HMOs is that they will assign a physician to 
someone and their family doctor or their gatekeeper that they have 
selected oftentimes loses that control. Let me give an example of what 
happened in my own district. We had an individual in Pasadena that the 
HMO doctor came in, the family doctor or their gatekeeper said this 
person actually was terminal, with cancer, and the HMO doctor came in 
and said, you need to be released, you cannot go here and if you come 
back to the hospital you have to go across town.
  So those constituents contacted our office and they expressed, our 
father is terminal and even our family doctor said he should stay in. 
After talking to that insurance company, they understood the error of 
their ways and they agreed to let that patient stay in there.
  A person should not have to call their Member of Congress to get 
adequate health care. We should be able to pass the legislation, have 
the President sign it and they should not have to do that so that HMO 
doctor, who was assigned, cannot go in and say you need to be released, 
not consulting with the family doctor. That came again from North Side 
Houston.
  I had another case in Pasadena. East End, in fact we share near East 
End where our new ball park is going to go up and the Astros are going 
to have their opening game, make HMOs accountable for better care. They 
have had horrible experiences. This is from Hagerman, near East End, 
almost in the district of the gentlewoman, but part of my district in 
East End Houston.
  Again, these are newsletter responses that come back and say how they 
need. Remove restrictions that HMOs and PPOs place on doctors. Again, 
the gag rules that are placed on them and also the restrictions that a 
doctor cannot say what to do.
  That is why this House last year passed a strong Patients' Bill of 
Rights bipartisanly and that is why the conference committee hopefully 
will, as we say in Texas, get up and do what is right. We need to do 
what is right and pass something for the whole country, not just say in 
Texas. I imagine the percentages in the district of the gentlewoman are 
the same. Two-thirds of the insurance policies in my district come 
under Federal law and not State law. So only a third of the people have 
the protections they have.
  Two-thirds of the people need us to pass a bill that is as strong as 
the bill for Texas, that they did in Texas, and that is why it is so 
important.
  Ms. JACKSON-LEE of Texas. Mr. Speaker, will the gentleman yield?
  Mr. GREEN of Texas. I yield to the gentlewoman from Texas.
  Ms. JACKSON-LEE of Texas. Mr. Speaker, I appreciate the gentleman 
sharing with us real-life stories because every time we do have our 
town hall meetings or we interact with constituents, there are a number 
of tragic stories. As I indicated, Mr. McGann passed away. He was 
suffering from HIV and was distraught to find out that his illness, 
which we all know now is an illness that can attack almost anyone, was 
not covered. It did not provide him the care that he needed.

                              {time}  1730

  What we need to do is to break the shackles or the intimidation 
process, so that, as the gentleman has so aptly said, access to health 
care does not have to be on the order of getting permission from the 
United States Congress, meaning that Congresspersons have to then 
intervene on behalf of their constituents to get simple health care.
  Mr. Speaker, I want to bring up the point of the specialty care and 
the block that most individuals get. It may be that they are suffering 
from sickle-cell; it may be that they are senior citizens with a number 
of ailments. People do not realize how difficult it is to get around as 
a senior citizen and to go to one primary care physician just to get, 
it is almost a ticket, just to get a slip of paper to say that you are 
referred to a specialist.
  Then one has to wait for a long period of time for that specialist to 
have time on his calendar, if you will, a physician's calendar. That is 
not necessarily an attack on the physician who is overwhelmed and 
overworked possibly, but then one has to wait to be seen by that 
particular specialist which delays one's diagnosis, and it also speaks 
to what the gentleman has just noted. The person who needed a 6-month 
checkup is given a 9-month. Why? Not for any other reason but to save 
money. But it is well known that the illness that they have needs a 6-
month detection.
  So what we are asking for is that there should not be a bar or a 
closed door to the need of our citizens to get health care in this 
great country where they are saying in one voice, whether

[[Page H746]]

it is the east end or the fifth ward, or whether it is the Heights, 
whether it is downtown Houston since that population is growing. I have 
heard that the stories do not respect whether or not one is a working 
person with an income of $25,000, someone who does not have health 
insurance, or someone who happens to be well-to-do. The problem is that 
the HMO, if you will, ties the hands of those who need health care; and 
we need to have those hands untied.
  Mr. GREEN of Texas. Mr. Speaker, I thank my colleague from Houston. 
That is so true. That is why this is not an issue of economics or 
demographics or anything else, whether one makes $100,000 a year, 
$25,000 a year. If one is in an HMO, one's health care can be delayed, 
it can be denied, unless we pass a strong managed care HMO reform bill.
  One of the issues I talked about a little bit earlier, and I want to 
address particularly, because I do not know if my colleague has heard 
about it, but I have, and particularly in meeting with some of my 
employers in the district, and that is again, their fears that they 
will be sued. I want to quote from the bill, section 302 of the bill 
that passed this House that says: nothing in this subsection should be 
construed as a cause of action under State law for the failure to 
provide an item or service which is specifically excluded under the 
group health plan for the employer. It does not authorize any cause of 
action against the employer or other plan sponsor maintaining a group 
health plan or against the employee of such person.
  The intent of this legislation is not to sue the employer or sue the 
employee of that employer unless they are making those medical 
decisions, unless they are involved in it. Again, my real-life 
experience before getting elected to Congress is that employers do not 
make that kind of decision. Employers go out and buy an insurance plan, 
what they can afford; and they do not decide whether someone should go 
to this doctor or that doctor or this hospital or that hospital. That 
is up to the plan to make that decision, with the premiums that they 
charge.
  So this bill actually prohibits lawsuits against the employer or the 
employee of that employer, based on health care, unless that employer 
is making that decision. Again, that is not the case. I do not know how 
we can make it any stronger. Frankly, during the debate last year on 
this legislation, I asked some employers, I said, if you can make it 
any stronger, please give me the language and we will make every effort 
to put it in. I never received any language.
  So this bill, the Dingell-Norwood bill, does not allow for employer 
lawsuits. So that is one of those straw men that get thrown up 
oftentimes during legislative debate. But managed care reform, real 
managed care reform, over 80 percent of the people support: Democrats, 
Republicans, Easterners, Westerners, Midwesterners. And that is why 
this Congress needs to pass it. If it is not in the year 2000, then 
hopefully the voters and the folks will remember this November that 
this Congress needs to be responsive to their requirements, 
particularly when we see 80 percent, and we hear the examples that we 
have given today and heard about.
  That is why it is so important that this Congress address a real 
Patients' Bill of Rights and include the 5 issues that we want to make 
sure they have: independent appeals, so they can get a timely medical 
decision; that we can eliminate those gag clauses; that we can have 
access to specialists; like my colleague said, women can go to their 
OB-GYN, not only for a specialist, but for their primary care; adequate 
emergency room service, and again, the example of not having to pass by 
an emergency room, or going to an emergency room with pain and then the 
doctors find out that you have some other illness and say no, you 
should have gone to your regular doctor. That is not the case. The 
issue is that they were experiencing pain originally, and whether it 
was the thyroid or heart or whatever should not matter.
  The last point, the best one, we can pass all of the legislation that 
we want in this bill, but if it does not hold the medical decision-
maker accountable, if the person is telling that person no, you should 
not get that test, if that person is not accountable, and again, they 
have been accountable under Texas law now for 2\1/2\ years and we have 
not seen a huge number of lawsuits. Again, Texans are not normally shy 
about going to court if they feel that they are aggrieved.
  Mr. Speaker, I yield to my colleague.
  Ms. JACKSON-LEE of Texas. Mr. Speaker, I thank the gentleman for that 
very excellent summary. I just wanted to go back to the point about 
pain, because the new science from medical professionals is that we 
should listen to the signals of pain. Just as the gentleman has 
indicated, here we have HMOs who tell us to go back home because in the 
example that I gave, she thought she was having a heart attack, but it 
happened to be thyroid, so that is contradictory to what the medical 
professionals are telling us, which is to listen to pain symptoms and 
act on them and not to ignore them.
  Let me just add that we holistically need to look over all at health 
care, and I hope at some time we will be able to pass the mental health 
parity bill. I think all of us have been supportive of that. That has 
not come to the floor. It has been filed every year, but we have not 
done that.
  Then, one of the issues that we need to continue to address, and that 
is why we should know that we are not solving everything with the 
Patients' Bill of Rights, so people who are fearful of it should 
realize that there are still issues to deal with.
  I have an omnibus mental health bill for children called Give a Kid a 
Chance, which is to give greater access to mental health care to our 
children and our families. There is certainly evidence through what we 
have seen in gun violence and children using guns that families are in 
great need of support systems. Mental health is a health issue, but we 
have not yet been able to address the question of mental health the way 
we should in this Congress.
  So I hope that this Special Order today emphasizes not only the HMO 
reform, but the overall need of addressing health care issues. I am 
looking forward to bringing my mental health bill both to committee and 
then to the floor of the House. But I want to do that as we move the 
Patients' Bill of Rights along, as well as the prescription drug 
discount, and finally address the questions that Americans have asked 
us to address.
  I thank the gentleman for yielding this time to me and for bringing 
to the attention of this Congress the need for HMO reform. I am happy 
to yield back to the gentleman.
  Mr. GREEN of Texas. Mr. Speaker, I thank my colleague again, because 
there is no doubt that this Congress needs to address a broad range of 
health care. We have a bill that passed the House, that is a strong 
Patients' Bill of Rights; and we need to take one step at a time, Mr. 
Speaker. If the conference committee will come out with a strong 
Dingell-Norwood bill just like passed this House, then we can put this 
issue behind us and we can address health care for veterans; we can 
address mental health and get on to other issues that are important.
  But, first of all, when people pay a premium, they have to make sure 
that they receive the health care that they are paying for; and that is 
what is so important about this Patients' Bill of Rights. They have to 
know that when they pay the money for their premium, that they are 
getting health care and not just getting a denial slip or delayed 
health care, because someone is making a decision that they are looking 
at the bottom line instead of the health care of that person.
  Mr. Speaker, again, I thank not only our Democratic leader, but also 
the colleagues of mine who have been here tonight.
  Mrs. MALONEY of New York. Mr. Speaker, last session, this House 
passed a sound and responsible managed care reform bill with solid 
support from both sides of the aisle.
  The conference committee has finally met and the appointees are now 
negotiating critical provisions such as direct access to OBGYNs for 
women and direct access to pediatricians for children.
  Faced with a daunting number of managed care reform bills, our fellow 
lawmakers in all 50 state legislatures are urging us to take action 
soon.
  Their pleas echo those of millions of patients, family members, and 
providers who feel disenfranchised and exploited by the Big Business of 
Big Medicine.

[[Page H747]]

  These are real patients with real diseases, real pain, and real fear.
  We have heard for so long about the onerous obstacles that patients 
face in getting the care they need.
  We have come together as a House to pass sound legislative remedies.
  Now let us finish the job we began last session without further 
delay.
  Mr. Speaker, these patients don't have any more time to wait, nor 
should they have to wait . . . We owe it to them to finally deliver the 
relief that is promised in the Norwood-Dingell bill.
  And the Patient's Bill of Rights isn't just about patients--it's 
about beleaguered health care providers gagged from speaking their 
expert opinion and prohibited from practicing to give the best medicine 
they know.
  No single piece of legislation passed during this Congress has more 
support and more urgency than the Patients' bill of rights.
  I call on my colleagues assigned to the conference committee to waste 
not one more minute in bringing this legislation to the desk of the 
President, so that the Patients' Bill of Rights can become law.

                          ____________________